Poverty in the United States is associated with higher risks of adverse physical and mental health outcomes. In 2019, approximately 10.5% of the U.S. population lived below the federal poverty line. Health disparities associated with poverty reflect differences in access to health care, housing quality, availability of nutritious food, exposure to pollution, and broader social and economic resources. These disparities vary across demographic groups and reflect the combined effects of factors including race, ethnicity, gender, and age.
Long-term exposure to poverty has been associated with increased mortality risk. A 2023 study published in the Journal of the American Medical Association found that experiencing poverty for ten or more years is among the leading risk factors for death in the United States, associated with approximately 300,000 deaths annually.
Mechanisms linking poverty and health Poverty affects health through multiple mechanisms operating at the individual, household, and community levels. Limited financial resources are associated with reduced access to adequate housing, nutritious food, and preventive health care, increasing the risk of adverse health outcomes.
At the individual and household level, food insecurity, a common consequence of poverty, has been associated with poor diet quality, obesity, and diet-related chronic diseases. Limited financial resources are associated with reduced access to nutritious foods, increasing reliance on lower cost, energy dense options.
Barriers to health insurance and medical care have also been associated with delays diagnosis and treatment. Individuals with lower income are more likely to be uninsured or underinsured, limiting their ability to obtain necessary medical services and preventative care and education. Structural factors, including the cost of coverage and fragmentation of the U.S. health care system, have been associated with gaps in access to care.
Chronic stress represents a biological pathway linking poverty and health. Financial instability and social disadvantage can contribute to prolonged activation of stress-response systems, often described as increased allostatic load. Elevated allostatic load has been associated with increased risk of cardiovascular disease and mortality.
At the community level, neighborhood conditions and structural factors also influence health. Socioeconomic disadvantage and residential segregation have been associated with adverse birth outcomes, hypertension, cancer, and premature mortality. These environments may limit access to health-promoting resources such as quality health care, education, and safe living conditions.
Together, these mechanisms associated with higher rates of chronic disease, poorer mental health outcomes, and reduced life expectancy among populations experiencing poverty.
Environmental health impacts The environment of people in poverty impacts their health in many aspects. High poverty areas experience problems associated with poor air quality, water pollution, hazardous and toxic waste, and noise pollution. According to Unhealthy Cities: Poverty, Race, and Place in America, poor air quality results in higher rates of children with asthma living in these areas, and nearly 2 million children with asthma live in areas that do not meet national ozone standards. These children are also exposed to greater amounts of allergens that trigger their asthma. Water pollution is also present impoverished cities due which results in unsanitary practices due to poor water supply and sanitation. Impoverished communities are prone to be in proximity to hazardous waste facilities which result in toxic waste dumping, chemical runoff, and water pollution within the area. Because many residents of low-income areas are desperate, they tend to not protest against incoming hazardous facilities. Therefore, these facilities tend to seek out these communities to build in, and this results in more health costs for those in the area. Low-income populations are also more exposed to pesticides, and a significantly higher amount of lead was found in African-American children living in inner-city areas. Neglected Tropical Diseases (NTDs) are also more prevalent in areas of high poverty such as the South and inner-city areas though they often get overlooked by physicians for other diseases.
Climate change also affects the health of those living in low-income communities. Climate change can result in a greater frequency of bad allergy days which results in weakened immune systems and increase asthma cases within the community. From air pollution, respiratory and cardiovascular diseases can worsen due to the greater amounts of chemicals in the atmosphere and hotter temperatures. The warmer temperatures also result in warmer surface water bodies which are better environments for tropical diseases to take root and spread. Climate change also results in a higher frequency of storms, hurricanes, and floods which can result in greater damage to infrastructure resulting in more financial stress for people in low-income communities.
Spatial
Health outcomes of those in poverty can also be determined by spatial, or geographic, location which is another aspect of the environment. Opportunities for healthcare, goods and services like food, and community are all based on geography. Childhood/early adulthood settings highly influence behavior, education, and careers. Those who are financially unstable can usually only find homes that are lower-priced in neighborhoods that are not invested in and are not managed well. These homes are often lower quality, and the costs are higher than what can be managed. According to The Link between Neighborhood Poverty and Wealth: Context or Composition?, Residents in a high-poverty neighborhood reports poor health 1.63 times more than a person in a low-poverty neighborhood, even when controlling for factors like education, marital status, and labor force status. For those living in rural areas, health services are not as accessible, and impoverished people go to doctors fewer times than their counterparts. The effect of spatial location is seen in both physical and mental health.
Poverty and physical health Poverty can affect health outcomes throughout a person's entire life. The affect may not always be expressed while an individual is impoverished. Mothers who are in poverty during their pregnancies may experience more health risks during their delivery, and their newborn may experience more health risks and markedly more behavioral problems during their development. Research has shown that low-income families and their children face the most pressing struggles when it comes to receiving medical attention. Since its most recent reauthorization in 2018, the Children's Health Insurance Program (CHIP) aims at improving healthcare coverage for vulnerable families experiencing homelessness. This includes youth up to 26 years of age, pregnant women, and new mothers. The initiatives for youth, as well as the automatic enrollment at birth, together represent a significant step towards enhancing effective health care access for families in this population.
To elaborate more, children in poverty have worse health outcomes during adulthood. This effect is especially pronounced for specific ailments, such as heart disease and diabetes. The impact persists even if a youth escapes poverty by adulthood, suggesting that the stress of poverty encountered during childhood or adolescence has a lasting effect. Previous research has identified the labor environments of the impoverished as more likely to contain risk factors for illness and disability relative to their non-impoverished counterparts. The implication is that the unique stresses of life within an impoverished community contribute to poorer health outcomes, even if the resident does not engage in any specific behavior detrimental to their health. Early into the COVID-19 pandemic in North America, being impoverished was associated with an increased likelihood of contracting COVID-19, as well as dying from it.
Poor housing results in many health problems. Accidents, respiratory disease, and lead poisoning can be caused by poorly built housing. There can also be a lack of safe drinking water, pests, and dampness in the house, and gonorrhea is associated with deteriorating houses. Mothers who live in poverty areas have lower rates of prenatal care and higher rates of infant mortality and low birth weight. Tuberculosis rates are also higher in high-poverty areas. Obesity is associated with poverty due to lack of infrastructure that supports a healthy lifestyle. Often, poverty-areas do not have places to walk or get healthy food nearby, and they are bombarded with unhealthy promotions like cigarettes, alcohol, and fast food. High-poverty areas also had higher death rates than low-poverty areas.
The cost of housing is a huge detriment to physical health. Housing is what the poor pay the most for on a regular basis, and this results in lack of funds for other basic needs like food and health. In a National Health Interview Survey, it was found that around 10% of American families did not receive needed medical care because of cost. Food insecurity also increases due to being unable to buy food due to cost.
According to a 2023 study published in JAMA, cumulative poverty of a decade or more is the fourth leading risk factor for death in the United States annually, being associated with 295,000 deaths. A single year of poverty was associated with 183,000 deaths in 2019, making it the seventh leading risk factor. Up until the age of 40, poor people's survival rates were essentially comparable to those of more affluent people, according to UCR researchers, but after that point, they died at a rate that was noticeably higher.
Poverty and mental health
After the 1980s decision to close long-term mental health-focused residential facilities, individuals suffered without adequate support systems and without access to community-based services. These individuals experienced unemployment, homelessness, and exposure to the criminal justice system, further exacerbating their mental illness.
Poverty in general also has a complex relationship with mental health. Being in poverty may itself provoke a condition of elevated emotional stress, known as "poverty distress". Poverty is also a precursor or risk factor for mental illness, particularly mood disorders, such as depression and anxiety. Schizophrenia is also strongly associated with poverty, occurring most frequently in the poorest classes of people all over the world, especially in more unequal countries. In a sort of reciprocating relationship, having mental illness is a major risk factor for being in poverty. Having a mental illness may inhibit a person's ability to work or deter employees from hiring them.
A hypothesis known as "drift hypothesis", posits that for people with psychiatric disorders (primarily schizophrenia), they tend to fall further down the socioeconomic ladder as their condition reduces their functionality. This hypothesis is an effort to establish that people with profoundly limiting psychiatric symptoms are more likely to descend economically, not that the financially challenged are more likely to present severe psychiatric disorders. People experiencing less severe symptoms are less likely to be affected by "drift".
With those in poverty having a greater likelihood of suffering from mental illness, the benefit of access to clinical psychotherapy treatments has been explored. Despite numerous barriers to access to care for low-income individuals, there is evidence that those who do receive care respond with significant improvements. This research supports policy measures for improved outreach and access-to-care measures designed to benefit those with low-incomes and mental health disorders.